Provider Demographics
NPI:1376280701
Name:GABLE, RICKY L (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:L
Last Name:GABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 GAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4195
Mailing Address - Country:US
Mailing Address - Phone:870-740-9931
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # SLOT837
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-10-09
Deactivation Date:2022-07-07
Deactivation Code:
Reactivation Date:2022-08-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program